1740624220 NPI number — SUNRISE CHILDREN'S SERVICES, INC.

Table of content: DR. LUTHER MYRON HEGLAND JR. MD (NPI 1033173513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740624220 NPI number — SUNRISE CHILDREN'S SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNRISE CHILDREN'S SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
EASTERN MOUNTAIN REGION FOSTER CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740624220
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1429
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MT WASHINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40047-1429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-538-1000
Provider Business Mailing Address Fax Number:
502-538-1100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
119 WEDDINGTON BRANCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PIKEVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41501-3204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-432-7001
Provider Business Practice Location Address Fax Number:
606-432-0047
Provider Enumeration Date:
04/26/2013

Additional Information

Authorized Official

Authorized Official Last Name:
C' DE BACA
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE ASSISTANT TO PRESIDENT
Authorized Official Telephone Number:
502-538-1010

Provider Taxonomy Codes

  • Taxonomy code: 253J00000X , with the licence number:  500241 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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